Long-term functional reconstruction of segmental tracheal defect by pedicled tissue-engineered trachea in rabbits
Long-term functional reconstruction of segmental tracheal defect by pedicled tissue-engineered trachea in rabbits
复制标题
兔带蒂组织工程气管对节段性气管缺损的长期功能重建。
DOI：
10.1016/j.biomaterials.2013.01.060
复制
发表时间：
2013-04-01
期刊：
影响因子：
14
通讯作者：
Zhou, Guangdong
中科院分区：
文献类型：
--
作者：
Luo, Xusong;Liu, Yi;Zhou, Guangdong
由于缺乏满意的气管替代物，长段气管缺损（> 6cm）的重建一直是气管外科的一大挑战。组织工程化气管（泰特）为解决这一难题提供了一种很有前途的方法，但在修复节段性气管缺损方面尚未取得突破性进展。最长存活时间仅为60天。气管段缺损重建失败的主要原因是肉芽组织过度生长导致的气道狭窄、软骨软化导致的气道塌陷和上皮缺失导致的黏膜嵌塞。为了解决这些问题，目前的研究提出了一种改进的策略，包括体外预培养，体内成熟，泰特移植物的预血管化以及使用硅胶支架。结果表明，体外预培养+体内植入的两步策略可以成功地再生管状软骨，其机械强度与免疫活性动物的天然气管相似。硅胶支架的使用有效抑制肉芽过度生长，防止气道狭窄，从而显着提高术后早期生存率。最重要的是，通过肌内植入和带蒂肌瓣移植，泰特移植物建立了稳定的血供，保证了管状软骨结构和功能的维持，加速了泰特移植物的上皮化，从而实现了节段性气管缺损的长期功能性重建。所有这些改进策略的整合最终实现了动物的长期存活：60%的家兔存活超过6个月。该方法为长段气管缺损的长期功能性重建提供了一种可行的方法。(C)2013爱思唯尔有限公司版权所有。
Due to lack of satisfactory tracheal substitutes, reconstruction of long segmental tracheal defects (>6 cm) is always a major challenge in trachea surgery. Tissue-engineered trachea (TET) provides a promising approach to address this challenge, but no breakthrough has been achieved yet in repairing segmental tracheal defect. The longest survival time only reached 60 days. The leading reasons for the failure of segmental tracheal defect reconstruction were mainly related to airway stenosis (caused by the overgrowth of granulation tissue), airway collapse (caused by cartilage softening) and mucous impaction (mainly caused by lack of epithelium). To address these problems, the current study proposed an improved strategy, which involved in vitro pre-culture, in vivo maturation, and pre-vascularization of TET grafts as well as the use of silicone stent. The results demonstrated that the two-step strategy of in vitro pre-culture plus in vivo implantation could successfully regenerate tubular cartilage with a mechanical strength similar to native trachea in immunocompetent animals. The use of silicone stents effectively depressed granulation overgrowth, prevented airway stenosis, and thus dramatically enhanced the survival rate at the early stage post-operation. Most importantly, through intramuscular implantation and transplantation with pedicled muscular flap, the TET grafts established stable blood supply, which guaranteed maintenance of tubular cartilage structure and function, accelerated epithelialization of TET grafts, and thus realized long-term functional reconstruction of segmental tracheal defects. The integration of all these improved strategies finally realized long-term survival of animals: 60% of rabbits survived over 6 months. The current improved strategy provided a promising approach for long-term functional reconstruction of long segmental tracheal defect. (C) 2013 Elsevier Ltd. All rights reserved.